Justia U.S. 8th Circuit Court of Appeals Opinion Summaries

Central States, a multi-employer trust fund governed by ERISA, provides health and welfare benefits to participants in the teamster industry. Student Assurance processed claims for student accident policies. Central States claimed that it paid medical expenses of $137, 204 for 13 junior high, high school, and college student-athletes who were covered dependents under its plan and who sustained athletic injuries. Central States sought reimbursement from Student Assurance, which refused to pay. Central States alleged that according to the coordination of benefits provision of its plan, the student accident policies supply primary coverage for the students’ covered medical expenses. Student Assurance claimed that the student accident policies are excess policies, and that they are not obligated to pay until Central States has reached the maximum contribution under its plan. Central States sued, citing federal common law and section 502(a)(3) of ERISA, seeking declaratory relief, restitution, and the imposition of an equitable lien and constructive trust to secure reimbursement for the benefits paid on behalf of the common insureds. The district court dismissed, and the Eighth Circuit affirmed, holding that the claims, while ostensibly seeking equitable remedies, were actually for legal relief that is unavailable under section 502(a)(3). View "Cent. States, SE & SW Areas Health & Welfare Fund v. Student Assurance Servs., Inc." on Justia Law

In 2011, a tornado struck and substantially damaged Midwest’s building and its contents. After the tornado, the medical practice was to relocate, which required substantial work. Until construction was complete, Midwest operated out of a temporary location, but was unable to operate at its normal capacity. Moving the repaired MRI machine to the new building required a crane; it was necessary to reinforce floors; replace exterior brick; and install pipe, specialized heating and air conditioning equipment, and copper shielding. The new location opened about a year after the tornado. Cincinnati Insurance paid Midwest the policy limit of $2,414,161.26 for the building; the policy limit of $388,000 for business personal property; and $828,081.75 for business income interruption and extra expenses. . Midwest requested “Extra Expense” reimbursement for the costs to repair and relocate the MRI machine and to replace the other specialty equipment necessary for normal operations. Cincinnati denied payment, contending the expenditures were covered under the Building or Business Personal Property provisions, for which it had paid the policy limits. The district court found the claimed expenses were recoverable under the Extra Expense provision. The Eighth Circuit affirmed, noting that the language of the Policy does not specifically exclude coverage under the Extra Expense provision if the expenses happen to fall under another coverage in the Policy. View "Midwest Reg'l Allergy Ctr., P.C. v. Cincinnati Ins. Co." on Justia Law

Asphalt hired a company that, from 2005-2008, sent about 44,000 fax advertisements to potential customers. FS, which received some of the faxes, filed a class-action, alleging violation of the Telephone Consumer Protection Act, 47 U.S.C. 227, seeking statutory damages of $500 for each fax. Asphalt notified Western, its insurer during the time when roughly 33,000 faxes were sent. The policies contained a deductible of $1,000 “per claim” for property damage, personal, and advertising injury, applicable to “all damages sustained by one person or organization as the result of any one claim” and to “legal expenses incurred in the handling and investigation of each claim.” Western hired a law firm to represent Asphalt, but did not refer to a reservation of rights. The firm handled the defense for four years. Western sent another letter, stating that Western intended to defend subject to a reservation of rights. Western sought a declaration that it owed no duty to defend or to indemnify. The district court determined that FS lacked standing to bring counterclaims and that Western had a duty to defend, having waived its defenses by waiting four years to issue a reservation-of-rights letter. The Eighth Circuit affirmed, holding that Western did not waive the $1,000 deductible, which applies separately to each fax, so that there is also no duty to indemnify. View "W. Heritage Ins. Co. v. Fun Servs. of Kan. City" on Justia Law

After his car was hit by a car driven negligently by Sheffer, Behlmann was billed $89,884.79 for medical treatment. Behlmann settled with Sheffer for $50,000, the limit of Sheffer’s policy. Behlmann sued his insurer, Century, for underinsured motorist benefits. Century argued that Behlmann’s medical treatment cost less than $50,000 and resulted from pre-existing conditions. The jury found for Century. Behlmann unsuccessfully requested a new trial, challenging the admission of evidence on the value of his medical treatment and the strike of the only African-American venire person. The Eighth Circuit affirmed, noting Missouri law: “Parties may introduce evidence of the value of the medical treatment rendered to a party that was reasonable, necessary, and a proximate result of the negligence of any party.” Behlmann did not establish that Century’s reasons for the strike were pretextual. Juror 4 was a long-time autoworker; he failed to disclose he was an autoworker despite relevant questioning; and he failed to disclose involvement in prior litigation. View "Behlmann v. Century Sur. Co." on Justia Law

Wieland is a member of the Missouri House of Representatives and obtains healthcare coverage for his family through the Missouri Consolidated Health Care Plan (MCHCP), a plan made available to him by his employer, the state. Until August 1, 2013, MCHCP offered an opportunity to opt out of contraceptive coverage under state law. The state and MCHCP discontinued offering that opportunity when the state opt-out was found to be preempted by the Patient Protection and Affordable Care Act (ACA), 42 U.S.C. 300gg, and its implementing regulation. The Wielands sued the U.S. Departments of Health and Human Services, Treasury, and Labor, challenging the ACA, as requiring them to obtain, and provide to their daughters, healthcare coverage for contraceptives, sterilization, and abortifacients in violation of their sincerely held religious beliefs. The district court dismissed for lack of standing. The Eighth Circuit reversed, stating that it is more than merely speculative that the Wielands’ injury would be redressed if they were granted the injunctive relief they seek. If the Supreme Court’s decision in Hobby Lobby overruled the case under which the opt-out was eliminated, the state law opt-out provision would likely again be available. View "Wieland v. Dep't of Health & Human Servs." on Justia Law

In 2006, Asoyia, an Iowa producer of soybean oil, purchased a general commercial agribusiness insurance policy and a commercial umbrella liability policy from Michigan Millers Mutual Insurance. In June 2007, a fire destroyed the Sunnyside Country Club, an Asoyia customer. Although Asoyia received a subrogation notice in June 2007, it did not notify Michigan Millers. No one associated with Asoyia participated in the fire investigation. In 2009 Sunnyside’s insurer, United, sued in state court, alleging Asoyia’s soybean oil caused the fire when a pile of laundered rags containing the oil spontaneously combusted. Asoyia then provided notice to Michigan Millers, which sought a declaration that it has no duty to defend or indemnify because of Asoyia’s prejudicial failure to provide prompt notice of the loss. A jury determined the late notice did not prejudice Michigan Millers. The Eighth Circuit affirmed, noting that the court instructed the jury to consider, whether “the fire investigation by United Fire and the Waterloo Fire Department was sufficiently thorough and the evidence was sufficiently well-preserved to allow Michigan Millers to fully investigate the fire after it received notice and whether Michigan Millers lost the opportunity to try “to settle the claim” or “to conduct, direct, or participate in a meaningful fire investigation.” View "Michigan Millers Mut. Ins. v. Asoyia, Inc." on Justia Law

In 1998, as required by his divorce decree, Jon purchased a $100,000 life insurance policy from Minnesota Life. Although the decree required Jon to maintain a life insurance policy payable to his children until his child support obligations ended, Jon designated his sister, Joetta, as beneficiary. His child support obligations ended in 2008. Jon died in 2013. On or near his body was found a handwritten note purportedly signed by Jon and expressing his intent that his daughter, Nikole, receive the proceeds of the life insurance policy. Joetta sought an order directing the insurer to pay the proceeds to her. Minnesota Life moved to interplead the funds and to join in the action. Nikole filed a counterclaim, seeking an order directing Minnesota Life to pay the proceeds to her. The district court granted Joetta summary judgment. The Eighth Circuit affirmed, reasoning that Jon did not take adequate steps to change the beneficiary from Joetta to Nikole under the policy’s change-of-beneficiary requirements and Nikole presented no evidence that Joetta agreed to give the proceeds to Nikole, or that Jon asked Joetta to do so View "Hearing v. Holloway" on Justia Law

Manuel’s home burned down while he and his family were vacationing in Las Vegas. Manuel had insured his home through MDOW with a policy providing $150,000 for the house, $75,000 for personal property, and $45,000 for added costs. Manuel filed a claim for the fire, but MDOW denied it. MDOW told Manuel that it believed he or someone acting on his behalf had intentionally set the fire and that Manuel’s claim form contained fraudulent information. Manuel sued. A jury found that MDOW proved by a preponderance of the evidence that Manuel “either burned his home or caused it to be burned.” The jury did not decide whether Manuel had intentionally misrepresented information during the fire investigation. The Eighth Circuit affirmed, agreeing even under an “implied bias” test of juror impartiality, there was insufficient potential bias alleged to warrant a new trial. The court rejected an argument that the court erred by allowing the testimony of MDOW’s expert witness, who disagreed with parts of the National Fire Protection Association 921 Guide for Fire and Explosion Investigations. View "Manuel v. MDOW Ins. Co." on Justia Law

Priesendorf, distraught and drunk, asked Purscell for a ride to a cemetery. On the return trip, Priesendorf's behavior became erratic. She put her foot on the accelerator, on top of Purscell's foot. Purscell got her to stop. Later, Priesendorf unbuckled her seat belt, scooted over, and repeated the behavior. Purscell was unable to remove his foot. Approaching a stop sign, he put his other foot on the brake, with no effect. Purscell saw the Carrs' vehicle. Priesendorf continued to press the accelerator. Purscell swerved, but the vehicles collided and overturned. The Carrs' vehicle caught fire. Priesendorf was dead at the scene. Later, Purscell learned the gravesite Priesendorf had visited belonged to a person who had been killed in an accident while Priesendorf was driving drunk. Priesendorf had attempted suicide following her friend's death; none of her other friends would give her a ride because of her erratic behavior. Infinity insured Purscell's vehicle with policy limits of $25,000 per person and $50,000 per accident for bodily injury. Infinity immediately put the full amount on reserve, with $25,000 designated to Priesendorf's fatality and $25,000 designated to the Carrs. Infinity immediately received a settlement offer from the Carrs, seeking policy limits. Tim's medical expenses were over $97,000 and ongoing. Amy had separate claimes. Infinity stated that it needed to investigate coverage. Infinity informed Purscell of his right to seek independent counsel. The Carrs withdrew their settlement offer. Infinity eventually filed an interpleader, depositing policy limits in court. A jury awarded Tim Carr $830,000 and Carr $75,000; Priesendorf's wrongful death claim settled for $7,764.50, leaving Purscell with a substantial judgment against him. Purscell sued Infinity, alleging bad faith and breach of fiduciary duty. The district court first and Eighth Circuit rejected the claims. View "Purscell v. Tico Ins. Co." on Justia Law

Kienstra, a Missouri resident, received treatment for uterine fibroid tumors at the Mayo Clinic in 2008. Her health plan concluded that her treatment fell outside the plan's coverage as experimental and requiring prior approval. Internal appeals failed. The plan is a self-funded multiple employer plan, maintained pursuant to collective bargaining agreements, and subject to the Employee Retirement Income Security Act, 29 U.S.C. 1002(1). The plan specified that any civil action for wrongful denial of medical benefits under ERISA must be filed within two years of the final date of denial. Kienstra filed suit almost two and a half years after she learned her claim had been denied. She unsuccessfully argued that the contractual limitations period was invalid because the plan's rules of construction stated that its terms should be read to comply with Missouri law, that a 10-year Missouri statute of limitations governed, and that a separate statute barred contracting parties from shortening that limitations period. The Eighth Circuit affirmed. There is no conflict between the plan's contractual limitations period and Missouri law; state law does not "apply of its own force to a suit based on federal law—especially a suit under ERISA, with its comprehensive preemption provision." View "Munro-Kienstra v. Carpenters' Health & Welfare Trust Fund of St. Louis" on Justia Law